US Trends in Refractive Surgery: The 2006 ISRS/AAO Survey Richard J. Duffey, MD ** David Leaming, MD...

$: US Trends in Refractive Surgery: The 2006 ISRS/AAO Survey Richard J. Duffey, MD ** David Leaming, MD ISRS / AAO Meeting Las Vegas- November 11, 2006 **$
US Trends in Refractive Surgery: The 2006 ISRS/AAO Survey

US Trends in Refractive Surgery: The 2006 ISRS/AAO Survey

Richard J. Duffey, MD **Richard J. Duffey, MD **

David Leaming, MDDavid Leaming, MDISRS / AAO MeetingISRS / AAO Meeting

Las Vegas- November 11, 2006Las Vegas- November 11, 2006** Author receives some travel expenses from TLCV ** Author receives some travel expenses from TLCV

** TLCV provided partial funding for this survey** TLCV provided partial funding for this survey

DUFFEY 2006

Why is this presentation LAST?Why is this presentation LAST?

Saving the best for last…flattering but NOSaving the best for last…flattering but NO Least damaging to attendance... Probably Least damaging to attendance... Probably

Not Not

Data just arrived via email from Analyze Data just arrived via email from Analyze yesterday and is literally…Hot Off the Press yesterday and is literally…Hot Off the Press

DUFFEY 2006

2006 Survey2006 Survey August mailing to 1500 U.S. members of ISRS/AAO.August mailing to 1500 U.S. members of ISRS/AAO. 167 responses analyzed by October 1st for 11% of the 167 responses analyzed by October 1st for 11% of the

U.S. ISRS/AAO membership.U.S. ISRS/AAO membership. Tenth year of refractive data collection.Tenth year of refractive data collection. Alphabet soup of refractive surgery.Alphabet soup of refractive surgery. Many new questions on flap thickness preference and Many new questions on flap thickness preference and

measurements, MMC use, enhancement tests, one-measurements, MMC use, enhancement tests, one-eyed patients, ectasia, co-management, SOC, etc., etc.eyed patients, ectasia, co-management, SOC, etc., etc.

DUFFEY 2006

I Am Currently Doing This SurgeryI Am Currently Doing This Surgery

94 94

71

57 57

26 27 30

18 2011

2 3 0010

2030

40

5060

70

8090

100

LASIK PRK LRI-IOL

RLE LRI CKPresb

LASEK P-IOL CKHyp

Epi-LASIK

ICR LTK KInlays

SE

'06

DUFFEY 2006

> 5 Cases / Month> 5 Cases / Month

24

63

5 5

27

1 0

8 5 3 3 00

10

20

30

40

50

60

70

80

PRK LASIK LASEK Epi-LASIK

LRI-IOL LRI ICR RLE P-IOL PTK CK Pres CK Hyp

'97'00'04'05'06

DUFFEY 2006


3

33

0 15

0 1 10

10

20

30

40

50

60

PRK LASIK LASEK Epi-LASIK LRI/IOL LRI P-IOL PTK

'97'98'99'00'01'02'03'04'05'06

DUFFEY 2006


27

13

10

5

10

15

20

25

30

LASIK PRK

'97'98'99'00'01'02'03'04'05'06

DUFFEY 2006

Preferred Surgery For 30 yo -10.00 Diopter MyopePreferred Surgery For 30 yo -10.00 Diopter Myope

1 1

710

40

31

35

03

3535

1315

0

5

10

15

20

25

30

35

40

Never PRK LASIK LASEK RLE P-IOL WAIT

'05'06

*

DUFFEY 2006

Preferred Surgery For 45 yo +3.00 D HyperopePreferred Surgery For 45 yo +3.00 D Hyperope

0

10

66

4 0

16

1 40

10

20

30

40

50

60

70

80

90

100

Never PRK LASIK LASEK CK RLE P-IOL WAIT

'99'00'01'02'03'04'05'06

DUFFEY 2006

Preferred Surgery For 45 yo +5.00 D HyperopePreferred Surgery For 45 yo +5.00 D Hyperope

1 1

8

0

61

7

23

0

10

20

30

40

50

60

70

Never PRK LASIK LASEK RLE P-IOL WAIT

'99'00'01'02'03'04'05'06

*

DUFFEY 2006

Surgery Done Bilateral At Same O.R. Visit Surgery Done Bilateral At Same O.R. Visit

8796

89 89 86

41

26

1 50

102030405060708090

100

PRK LASIK Epi-LASIK

LASEK CK ICR K Inlay RLE P-IOL

'97'98'00'04'05'06

DUFFEY 2006

Had Refractive Surgery Performed on YourselfHad Refractive Surgery Performed on Yourself

3

7

19

0 0 0 0

3

0

5

10

15

20

25

LRI PRK LASIK LASEK ICR RLE P-IOL CK

'98'99'00'01'02'03'04'05'06

32%

DUFFEY 2006

Excimer Laser Most Commonly UsedExcimer Laser Most Commonly Used

67

17

3 6 800

10

20

30

40

50

60

70

80

90

VisX Alcon Nidek Wavelight B and L Others

'97'98'99'00'01'02'03'04'05'06

DUFFEY 2006

Microkeratome Most Commonly UsedMicrokeratome Most Commonly Used

3

30

9 8 6 4

2014

6

00

10

20

30

40

50

60

B-L Zyop B-L Hansa Moria C-B MoriaDisp

Moria M2 Moria LSK Intralase Amadeus Nidek B-D

'98'00'04'05'06

27

33

DUFFEY 2006

Topography Unit Most Commonly Used Topography Unit Most Commonly Used

32

24

12

79 9

6

0

5

10

15

20

25

30

35

40

45

Zeiss-Hum

Orbscan EyeSys Tomey Nidek Pentacam Others

'98'00'04'05'06

*

DUFFEY 2006

Epi-Keratome Use Epi-Keratome Use

18

53

40

37

0

10

20

30

40

50

60

Yes Moria E-K

AmadOpus 2

VisijetEpi

Cent SES

'98'99'00'01'02'03'05'06

DUFFEY 2006

Pupil Gauge Instrument UsePupil Gauge Instrument Use

44

38

5 3 1

10

05

101520253035404550

Colvard Card Procyon Neuroptic Pupilscan Other

'02'03'04'05'06

DUFFEY 2006

Preferred Surgery for PresbyopiaPreferred Surgery for Presbyopia

42

20

5 6

16

10

0 00

10

20

30

40

50

60

Mono Mod Mono CK-blended CrystaLens ReStor ReZoom Array Technis

'02'03'04'05'06

DUFFEY 2006

Wavefront AnalyzerWavefront Analyzer

88

12

70

25

6 4 26

0

10

20

30

40

50

60

70

80

90

Yes No VisX Alcon B and L Tracey Allegr Other

'02'03'04'05'06

DUFFEY 2006

Wavefront-Guided Custom Ablations in Your PracticeWavefront-Guided Custom Ablations in Your Practice

1115

6

13

55

0

10

20

30

40

50

60

0% 1-25% 26-50% 51-75% 76-100%

'03'04'05'06

DUFFEY 2006

ComanagementComanagement

56

4440

92 5

0

10

20

30

40

50

60

70

80

Yes No 1-25% 26-50% 51-75% 76-100%

'00'01'03'04'05'06

DUFFEY 2006

Do You Intra-operatively Measure Flap Thickness?Do You Intra-operatively Measure Flap Thickness?

3135 37

6965 63

0

10

20

30

40

50

60

70

Yes No

'04'05'06

DUFFEY 2006

Preferred Flap Thickness (when no other constraints)Preferred Flap Thickness (when no other constraints)

1

20

53

21

6

0

10

20

30

40

50

60

80 100 120-130 150-160 180+

'04'05'06

DUFFEY 2006

Minimum Residual Stromal Thickness Requirement for LASIKMinimum Residual Stromal Thickness Requirement for LASIK

0 1

64

18 17

1 00

10

20

30

40

50

60

70

80

200 225 250 275 300 325 350

'04'05'06

DUFFEY 2006

Total Cases of Post LASIK Ectasia as the Primary Surgeon in CareerTotal Cases of Post LASIK Ectasia as the Primary Surgeon in Career

60

1613

5 3 1 2 00

10

20

30

40

50

60

0 1 2 3 4 5 6 to 10 >10

'04'05'06

DUFFEY 2006

14

48

32

13

4

0

5

10

15

20

25

30

35

40

45

50

540microns

520 500 480 460 no limit

'05'06

Minimum Cent. Corneal Pachymetry for LASIK (all other parameters normal)

Minimum Cent. Corneal Pachymetry for LASIK (all other parameters normal)

80%

DUFFEY 2006

Mitomycin-C Use (MMC)Mitomycin-C Use (MMC)

18

9

74

0

10

20

30

40

50

60

70

80

Never Haze Only Prophylaxis andHaze

'04'05'06

DUFFEY 2006

Will You Perform Refractive Surgery on One-Eyed PatientsWill You Perform Refractive Surgery on One-Eyed Patients

4555

0

1020

3040

5060

7080

90100

Yes No

'04'05'06

DUFFEY 2006

Post-Op AntibioticPost-Op Antibiotic

48 49

1 0 2 0 0 00

10

20

30

40

50

60

Zymar Vigamox Ocuflox Quixin Ciloxan Tobra Gent Other

'02'03'04'05'06

DUFFEY 2006

82

105 3

0 10

10

20

30

40

50

60

70

80

90

Pred FML Lotepr Dex Vexol Other

'06

Post-Op SteroidPost-Op Steroid

DUFFEY 2006

Post-Op NonsteroidalsPost-Op Nonsteroidals

63

19

108

10

10

20

30

40

50

60

70

Acular-L Nevanac Xibrom Voltaren Other

"06

DUFFEY 2006

Location of Phakic-IOL SurgeryLocation of Phakic-IOL Surgery

2 2

78 79

16 15

4 4

0

10

20

30

40

50

60

70

80

Hospital OR ASC OR In-OfficeModified OR

Clean LASIKRoom

'05'06

DUFFEY 2006

’06 ISRS/AAO Survey Conclusions’06 ISRS/AAO Survey Conclusions

LASIK dominates between -10D and +3D.LASIK dominates between -10D and +3D. P-IOL for higher than -10D myopes. P-IOL for higher than -10D myopes. RLE for high hyperopes (61%).RLE for high hyperopes (61%). Monovision is the most sought goal for presbyopic Monovision is the most sought goal for presbyopic

patients seeking refract surgery (42%), but 33% patients seeking refract surgery (42%), but 33% are now implanting modern presbyopic IOL’s.are now implanting modern presbyopic IOL’s.

Trend toward thinner flaps (mechanical or laser).Trend toward thinner flaps (mechanical or laser). Almost one-third of us (32%) have had modern Almost one-third of us (32%) have had modern

refractive surgery done on our refractive surgery done on our ownown eyes! eyes!

DUFFEY 2006

King….Queen….Rising PrinceKing….Queen….Rising Prince

LASIKLASIK PRKPRK RLERLE VISX StarVISX Star Alcon LADAR ------Alcon LADAR ------ HansaHansa MoriaMoria IntraLaseIntraLase Zeiss-HumZeiss-HumOrbscanOrbscan PentacamPentacam ReStorReStor ReZoomReZoom ------------ Zymar/VigaZymar/Viga ------------ ------------ Acular-LAcular-L NevanacNevanac ------------

Thanks to the ISRS/AAO leadership for their support and for your participation in the

2006 Survey

Thanks to the ISRS/AAO leadership for their support and for your participation in the

2006 Survey We look forward to your response to We look forward to your response to

the 2007 survey next fallthe 2007 survey next fall

Complete results at Complete results at www.duffeylaser.comwww.duffeylaser.com

US Trends in Refractive Surgery: The 2006 ISRS/AAO Survey Richard J. Duffey, MD ** David Leaming, MD...

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